Provider Demographics
NPI:1215696711
Name:ROBERSON COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:ROBERSON COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LPC, LPC-S
Authorized Official - Phone:601-919-7578
Mailing Address - Street 1:1164 MARTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-6136
Mailing Address - Country:US
Mailing Address - Phone:601-919-7578
Mailing Address - Fax:
Practice Address - Street 1:1635 LELIA DR STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4876
Practice Address - Country:US
Practice Address - Phone:601-919-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health